Sir James Young SimpsonChapter
VII. The Fight for Anaesthesia (1847 onwards)

His faith in chloroform—Confused public opinion
on the subject-Personal attacks—Opposition on professional grounds—His
reply— Opposition on moral grounds—His reply—Opposition on religious
grounds—His reply—Her Majesty the Queen anaesthetised—Indiscrete
supporters—The Edinburgh teaching of anaesthesia administration—The
far-reaching effects of the successful introduction of anaesthesia.

PROFESSOR SIMPSON firmly believed that he
possessed now in chloroform an anaesthetic agent "more portable, more
manageable and powerful, more agreeable to inhale, and less exciting" than
ether, and one giving him " greater control and command over the
superinduction of the anaesthetic state." Fortified by this belief, full of
facts relating to the subject, and fired with zeal and enthusiasm, he was
prepared to meet the opposition which from his knowledge of human nature he
must have anticipated. So bravely and so emphatically did he champion the
cause that he became identified with it in the public mind. The revelation
of anaesthesia, the discovery of chloroform, and the application of
anaesthetics to surgery as well as to midwifery were attributed to him by
all classes of the community, not even excepting many of his own profession.
Chloroform was spoken of as if ether had never existed ; and chloroform and
chloroforming displaced the terms anaesthetic and anaesthetising in ordinary
talk—such unwieldy terms were naturally abandoned when there was the excuse
that chloroform was universally considered the best substance of its class.
Simpson made no attempt as Morton had done to patent his discovery under a
fanciful name for his own pecuniary profit; but widely spread abroad every
particle of knowledge concerning it that he possessed, so that every
practitioner was forthwith enabled to avail himself thereof for the benefit
of his patients.

Partly owing to his own enthusiasm and his
strong belief in the superiority of chloroform over ether, and partly owing
to the confusion prevailing in' general circles as to the history of
anaesthesia, no small number of attacks were directed against Simpson
personally by those who either were jealous of his achievements, or who
considered that the part taken by themselves or their friends in the
establishment of this new era in medical science had been slighted or
overlooked. Simpson took all these as part of the fight into which he had
entered. His nature was not sensitive to 112 such personal attacks; he
replied to them, cast them off, and went on his way unaffected. He handled
some of these opponents somewhat severely when they accused him of
encouraging the public belief in him as the discoverer of anaesthesia. It is
clear to us to-day after anaesthesia has been on its trial for fifty years
that Simpson magnified the superiority of chloroform over ether, and was led
by that feeling to look on the history of ether as but a stage in the
history of the greater chloroform. He regarded chloroform as the only
anaesthetic ; his utterances betrayed this feeling, and offence was
naturally taken by the introducers and advocates of ether. His opinion of
chloroform was shared by the leading European surgeons to such an extent in
his day that shortly after his death Professor Gusserow, of Berlin, stated
that with a few exceptions almost all over the earth nothing else was used
to produce anaesthesia but chloroform.

The real fight for anaesthesia was against those
who found in the practice something which ran contrary to their beliefs or
principles. There were first those who objected on purely medical grounds ;
secondly, those who took exception to it from a moral point of view ; and
thirdly, those who found their religious convictions seriously offended by
the new practice.

The medical opponents were, perhaps, the most
powerful certainly it was they who had first to be won over, for without the
support of the profession the cause was in danger. It was urged first of all
that the use of anaesthetics would increase the mortality, then very great,
of surgical operations, and those who took their stand upon this ground were
men who had at first denied the possibility of making operations painless,
and had been driven to abandon that opinion only by a clear demonstration of
the fact. To meet this form of opposition he instituted a laborious and
extensive statistical investigation in order to compare the results obtained
in hospitals where anaesthetics were used with those where the operations
were performed on patients in the waking state. He took care that the
reports dealt with the same operations under, as nearly as possible, similar
conditions in each case. He obtained returns from close upon fifty hospitals
in London, Edinburgh, Dublin, and various provincial towns. One of the most
fetal operations in those days, and one dreaded by patient and surgeon
alike, was amputation of the thigh. In 1845 Professor Syme said that the
stern evidence of hospital statistics showed that the average frequency of
death after that operation was not less than 60 to 70 per cent., or above
one in every two operated upon. Simpson fearlessly collated statistics of
this operation amongst the others, and proved that when performed under
anaesthetics amputation of the thigh had its mortality reduced to 25 per
cent. His figures were as follows

He pointed to the above table as a proof that
far from increasing the mortality of this operation the introduction of
anaesthetics had already led to a saving of from eleven to twenty lives out
of every hundred cases. He acknowledged that the number of cases he had
collected (145) was somewhat small from a statistical point of view ; but he
confidently asserted that future figures would show greater triumphs. The
tables of other operations showed similar results, and he entered
exhaustively into the subject in a paper published in 1848. The paper was
entitled, w Does Anaesthesia increase or decrease the mortality attendant
upon surgical operations ? " According to his wont, he headed it with a
quotation from Shakspeare :

Victorious in this encounter, he turned to those
who urged that anaesthetics were responsible for various kinds of ills such
as a tendency to haemorrhage, convulsions, paralysis, pneumonia, and various
kinds of inflammatory mischief as well as mental derangement. He combated
these contentions until the end of his career; and not only proved that the
objections were visionary, but showed that for one of the alleged evils
formerly often seen after operations, viz., convulsions, chloroform, far
from being a cause, was one of our most powerful remedies.

But the professional opponents of anaesthesia
were most emphatic in the denunciation of its use in midwifery. Pain in the
process of parturition was, they said, "a desirable, salutary, and
conservative manifestation of life-force": neither its violence nor its
continuance was productive of injury to the constitution. Strong opposition
on these grounds came from the Dublin School,and with characteristic
boldness Simpson turned to the statistics of their own lying-in hospital to
prove his contention that to abolish parturient pain was to diminish the
peril of the process. Again the statistics stood him in good stead; he
flourished them triumphantly before his opponents, and proceeded to deal
with those who asserted that the use of anaesthetics was accompanied by
danger to life. He pointed out that, although unquestionably there were some
dangers connected therewith, they were insignificant compared with the
dangers in both surgery and midwifery which their use averted. Pain itself
was a danger; shock in surgery was responsible for many untimely deaths upon
the operating table; by preventing these chloroform saved countless lives.
His arguments were characterised by painstaking thoroughness and evidenced
wide reading. In addressing Professor Meigs, of Philadelphia, he said :—

"First, I do believe that if improperly and
incautiously given, and in some rare idiosyncrasies, ether and chloroform
may prove injurious or even fatal— just as opium, calomel, and every other
powerful remedy and strong drug will occasionally do. Drinking cold water
itself will sometimes produce death. 'It is well known,' says Dr. Taylor, in
his excellent work on Medical Jurisprudence, 'that there are many cases on
record in which cold water, swallowed in large quantity and in an excited
state of the system, has led to the destruction of life/ Should we therefore
never allay our thirst with cold water? What would the disciples of Father
Mathew say to this? But, secondly, you and others have very unnecessary and
aggravated fears about the dangers of ether and chloroform, and in the
course of experience you will find these fears to be, in a great measure,
perfectly ideal and imaginary. But the same fears have, in the first
instance, been conjured up against almost all other innovations in medicine
and in the common luxuries of life. Cavendish, the secretary to Cardinal
Wolsey, tells us in his life of that prelate, that when the cardinal was
banished from London to York by his master—that regal Robespierre, Henry the
Eighth—many of the cardinal's servants refused to go such an enormous
journey—'for they were loath to abandon their native country, their parents,
wives, and children.' The journey which can new be accomplished in six hours
was considered then a perfect banishment. ... In his Life of Lord
Loughborough, John Lord Campbell tells us that when he (the biographer)
first travelled from Edinburgh to London in the mail-coach the time had been
reduced (from the former twelve or fourteen days) to three nights and two
days; 'but,' he adds, 'this new and swift travelling from the Scots to the
English capital was wonderful, and I was gravely advised to stop a day at
York as several passengers who had gone through without stopping had died of
apoplexy from the rapidity of the motion' ('Lives of the Lord Chancellors').
Be assured that many of the cases of apoplexy, &c., &c., alleged to arise
from ether and chloroform, have as veritable an etiology as this apoplexy
from rapid locomotion, and that a few years hence they will stand in the
same light in which we now look back upon the apoplexy from travelling ten
miles an hour. And as to the supposed great moral and physical evils and
injuries arising from the use of ether and chloroform, they will by and by,
I believe, sound much in the same way as the supposed great moral and
physical evils and injuries arising from using hackney coaches, which were
seriously described by Taylor, the water-poet, two or three centuries ago
when these coaches were introduced. Taylor warned his fellow-creatures to
avoid them, otherwise 'they would find their bodies tossed, tumbled,
rumbled, and jumbled' without mercy. i The coach,' says he, cis a. close
hypocrite, for it hath a cover for knavery ; they (the passengers) are
carried back to back in it like people surprised by pirates, and moreover it
maketh men imitate sea-crabs in being drawn sideways, and altogether it is a
dangerous carriage for the commonwealth.' Then he proceeds to call
them c hell-carts,' &c., and vents upon them a great deal of other abuse
very much of the same kind and character as that lavished against
anaesthetics in our own day."

Following out the same line of reasoning he
brought to the minds of medical opponents how the introducers of such useful
drugs as mercury, antimony, and cinchona bark had met with now
long-forgotten but stubborn opposition ; and he reminded surgeons of the
stern obstinacy with which the introduction of the ligature of arteries had
been long objected to and the barbarous method of arresting bleeding with
red-hot irons had been preferred. But in the history of the discovery and
introduction of vaccination by Jenner he found a strong parallel; and he
wrote a pregnant article to prove that mere opinion and prejudgments were
not sufficient to settle the question of the propriety or impropriety of
anaesthetic agents, illustrating it from the story of vaccination. The
result of vaccination had been to save during the half century since its
introduction a number of lives in England alone equal to the whole existing
population of Wales; and in Europe during the same period it had preserved a
number of lives greater than the whole existing population of Great Britain.
And yet Jenner, when he first announced his discovery, had encountered the
most determined opposition on the part of many of his professional brethren,
who ridiculed and bitterly denounced both him and his discovery; whilst
ignorant laymen announced that small-pox was ordained by heaven and
vaccination was a daring and profane violation of holy religion. He pointed
out that these objections had been slowly and surely crushed out of
existence by accumulated facts, and predicted that the ultimate decision
concerning anaesthesia would come to be based, not upon impressions,
opinions, and prejudices, but upon the evidence of " a sufficient body of
accurate and well-ascertained facts." To these facts, as has been indicated,
he subsequently successfully appealed.

Those who objected to anaesthesia
on moral grounds directed their attacks chiefly against its use in
midwifery. They not only condemned that application as iniquitous, but went
the length of asserting that the birth of past myriads without it proved how
unnecessary it was, and that Nature conducted the whole process of birth
unaided in a greatly superior manner. The pains associated with parturition
were actually beneficial, they said. Simpson answered this by showing that
the proper use of anaesthetics shortened parturition, and by diminishing the
amount of pain led to more rapid and more perfect recoveries. The leading
exponent of the Dublin School of Midwifery at that time foolishly wrote that
he did not think any one in Dublin had as yet used anaesthetics in
midwifery; that the feeling was very strong against its use in ordinary
cases, merely to avert the ordinary amount of pain, which the Almighty had
seen fit— and most wisely, no doubt—to allot to natural labour ; and in this
feeling he (the writer) most heartily concurred. Simpson's private comment
on this remarkable epistle at once showed his opinion of it, and ridiculed
the objection out of existence. He skilfully parodied the letter thus:—"I do
not believe that any one in Dublin has as yet used a carriage in locomotion;
the feeling is very strong against its use in ordinary progression, merely
to avert the ordinary amount of fatigue which the Almighty has seen fit—and
most wisely, no doubt—to allot to natural walking; and in this feeling I
heartily and entirely concur."

He twitted the surgeons who opposed him with
their sudden discovery, now that anaesthetics were introduced, that there
was something really beneficial in the pain and agony caused by their
dreaded knife. Such a contention contraverted his cherished principle that
the function of the medical man was not only to prolong life, but also to
alleviate human sufferings.

He quoted authorities of all times to show that
pain had been always abhorred by physicians and surgeons, commencing with a
reference to Galen's aphorism— 'Dolor dolentibus inutile est" (tt pain is
useless to the pained "); citing Ambroise Pare, who said that pain ought to
be assuaged because nothing so much dejected the powers of the patient; and,
finally, reproducing the words of modern authors, who asserted that, far
from being conducive to well-being, pain exhausted the principle of life,
and in itself was frequently both dangerous and destructive. He brought
forward a collection of cases where in former days patients had died on the
operating-table, even before the surgeon had begun his work, so great was
the influence of the mere fear of pain; and reminded those who attributed
occasional deaths on the operating-table to the influence of the anaesthetic
of the numerous cases in bygone days where death occurred whilst the surgeon
was at work. He recalled also how the great surgeon of St. Thomas's
Hospital, Cheselden, had-abhorred the pain which he caused in the process of
his work, and longed for some means for its prevention. " No one," said
Cheselden, w ever endured more anxiety and sickness before an operation "
than himself.

Simpson did not forget to look at the subject
from the patient's point of view, and reproduced the letter from an old
patient, which has been already quoted (Chapter VI.).

The soldier and sailor, brave unto heroism in
facing the enemy, never fearing the death which stared them in the face in
its most horrible form whilst answering the call of duty, would quail like
children at the mere thought of submitting to the deliberate knife of the
surgeon. Were quibbles about the efficacy of pain to stand in the way of the
merciful prevention of such suffering by the process of anaesthetisation?

Those who opposed him with this curious idea,
that pain after all was beneficial, were some of them men of no mean
standing in the profession. Gull, Bransby Cooper, and Nunn were amongst
those whom he had to silence. After replying to their
arguments seriatim with all -his polemic power, he referred them once more
to the evidence of facts and of facts alone as set forth by his statistics.
Had he lived but a twelvemonth longer than he did he would have been able to
conjure up a picture of the incalculable amount of suffering prevented by
the eighteen hundred pounds of chloroform which were forwarded to the rival
armies from one firm of chemists alone during the Franco-Prussian war ;
happily for the wounded within and around Paris, there was then no longer
any doubt as to the propriety of employing anaesthetics.

The religious objections to the use of
anaesthetics could scarcely be met with statistics. Foolish as they now
appear to us after the lapse of time, and with the practice they attempted
to repel universally adopted, they were nevertheless urged in good faith by
clergy and laity of various denominations. The same kind of bigotry had met
the introduction of vaccination, and Simpson himself remembered how many
people had opposed the emancipation of the negroes on the ground that they
were the lineal descendants of Ham, of whom it was said "a servant of
servants shall he be unto his brethren." Sir Walter Scott reminds us, in
"Old Mortality," of the spirit which met the introduction of fanners to
separate the chaff from the corn, which displaced the ancient method of
tossing the corn in the air upon broad shovels. Headrigg reproved Lady
Bellenden for allowing the new process to be used on her farm, " thus
impiously thwarting the will of Divine Providence by raising a wind for your
leddyship's ain particular use by human art, instead of soliciting it by
prayer or waiting patiently for whatever dispensation of wind Providence was
pleased to send upon the sheeling hill."

To-day in South Africa the same spirit is seen.
Honest countryfolk of European descent are earnestly counselled by their
spiritual advisers to submit patiently to the plague of locusts on the
ground that it comes as a punishment from Providence. These worthy men
stolidly witness their cornfields and their grass lands being eaten bare
before their eyes in a few hours, whilst their more enlightened neighbours,
brought up in another faith, resort with success to 124 all sorts of
artifices to ward off the destructive little invaders.

It is pleasant to be able to record that Dr.
Chalmers, one of the heroes of Scots religious history, not only
countenanced chloroform by witnessing operations performed under it in the
Royal Infirmary, but when requested to deal in a magazine article with the
theological aspect of anaesthesia refused on the ground that the question
had no theological aspect, and advised Simpson and his friends to take no
heed of the " small theologians" who advocated such views. This was futile
advice to give to one of Professor Simpson's controversial propensities; he
entered with keen enjoyment into the fray with these "religious" opponents.
His famous pamphlet, entitled," Answer to the Religious Objections advanced
against the employment of Anaesthetic Agents in Midwifery and Surgery,"
fought his enemies with their own weapons by appealing with consummate skill
to Scripture for authority for the practice. The paper was headed with two
scriptural verses:—" For every creature of God is good, and nothing to be
refused if it be received with thanksgiving" (i Timothy iv. 4). "Therefore
to him that knoweth to do good and doeth it not to him it is sin " (James
iv. 17).

The principal standpoint of the religious
opponents was the primeval curse upon womanhood to be found in Genesis.
Simpson swept the ground from under his opponents' feet by reference to and
study of the original Hebrew text. The word translated—"sorrow" ("I will
greatly multiply thy sorrow ... in sorrow shalt thou bring forth")—was the
same as that rendered as "sorrow" in the curse applied to man ("in sorrow
shalt thou eat of it all the days of thy life "). Not only did the Hebrew
word thus translated sorrow really mean labour, toil, or physical exertion ;
but in other parts of the Bible an entirely different Hebrew word was used
to express the actual pain incident to parturition. The contention, then,
that sorrow in the curse meant pain was valueless. Chloroform relieved the
real pain not referred to in the curse, whereas it had no effect upon the
sorrow or physical exertion.

If, however, the curse was to be taken literally
in its application to woman as these persons averred, and granting for the
moment that sorrow did mean pain, their position was entirely illogical. If
one part of the curse was to be interpreted literally, so must be the other
parts, and this would have a serious effect of a revolutionary nature upon
man and the human race all over the face of the earth. Literally speaking,
the curse condemned the former who pulled up his thorns and thistles, as
well as the man who used horses or oxen, water-power, or steam-traction to
perform the work by which he earned his bread j for was he not thereby
saving the sweat of his face?

Pushed further, the same argument rendered these
contentions more absurd and untenable. Man was condemned to die—" dust thou
art and unto dust thou shalt return." What right had the physician or
surgeon to use his skill to prolong life, at the same time that he
conscientiously abstained from the use of anaesthetics on the ground that
they obviated pain sent by the Deity? Nay, more; sin itself was the result
of the Fall; was not the Church herself erroneously labouring to turn
mankind from sin?

In a truer and more serious religious spirit he
reminded his foolish opponents of the Christian dispensation, and pointed
out how the employment of anaesthesia was in strict consonance with the
glorious spirit thereof.

Some persons broadly stated that the new process
was unnatural; even these he condescended to answer. "How unnatural,"
exclaimed an Irish lady, "for you doctors in Edinburgh to take away the
pains of your patients." "How unnatural," said he, "it is for you to have
swam over from Ireland to Scotland against wind and tide in a steam-boat."

A son of De Quincey in his graduation thesis
humorously supported Professor Simpson. He argued that the unmarried woman
who opposed anaesthetics on the ground that her sex was condemned by the
curse to suffer pains, broke the command herself " in four several ways,
according to the following tabular statement":—

"1. She has no conception.
2. She brings forth no children.
3. Her desire is not to her husband.
4. The husband does not rule over her."

De Quincey himself supported his son in a letter
appended to the thesis thus :—"If pain when carried to the stage which we
call agony or intense struggle amongst vital functions brings with it some
danger to life, then it will follow that knowingly to reject a means of
mitigating or wholly cancelling the danger now that such means has been
discovered and tested, travels on the road towards suicide. It is even worse
than an ordinary movement in that direction, because it makes God an
accomplice, through the Scriptures, in this suicidal movement, nay, the
primal instigator to it, by means of a supposed curse interdicting the use
of any means whatever (though revealed by Himself) for annulling that
curse."

But the Bible furnished Simpson with the most
powerful argument of all in Genesis ii. 21, where it is written : " And the
Lord God caused a deep sleep to fall upon Adam; and he slept5 and He took
one of his ribs and closed up the flesh instead thereof." He strengthened
his position by explaining that the word rendered "deep sleep" might more
correctly be translated "coma" or "lethargy." He had taken the full measure
of his opponents when he answered them with this quotation ; it was a reply
characteristic of the man, and completely defeated these self-constituted
theologians with their own weapons. They had attacked him as a man of
science, and found 128 that his knowledge of the Scriptures excelled their
own. He did not fail to read these people a lesson, and point out the harm
done to true religion by such conduct and arguments as theirs, reminding
them that if God had willed pain to be irremovable no possible device of man
could ever have removed it.

Such was the great fight—the fight for
anaesthesia— which Simpson fought and won. He was the one man who by his own
individual effort established the practice of anaesthesia, while Morton has
the honour of being the one man without whom anaesthesia might have remained
unknown. Such was the opposition encountered, and such was the timidity of
his professional brethren, that but for Simpson's courageous efforts it
would have been the work of years to bring about what it was granted to him
to accomplish in a brief period ; if fear, ridicule, contempt, and bigotry
had not perhaps sunk the new practice into oblivion. Of the hundreds who are
daily mercifully brought under the influence of chloroform and ether, few
are aware what they owe to Simpson, even if they know how great is the
suffering which they are spared.

Simpson felt that the victory was indeed
complete when in April, 1853, he received a letter from Sir James Clark,
physician in ordinary to Her Majesty, informing him that the Queen had been
brought under the influence of chloroform, and had expressed herself as
greatly pleased with the result. It was at the birth of the late Prince
Leopold that Her Majesty set her subjects this judicious example.

Much trouble to the cause was occasioned by
enthusiasts who administered chloroform with more zeal than discretion, and
without any study of the principles laid down by Simpson. As a result of
imperfect trials, some persons went the length of saying that there were
people whom it was impossible to anaesthetise at all, and others who could
be only partially anaesthetised. Wrong methods of administration were used.
Simpson patiently corrected these, and carefully instructed his students, so
that the young graduates of Edinburgh University carried his teaching and
practice into all parts of the world. Syme also took up the cause, and
valuable work was done in London by Snow, and later by Clover. The teaching
of Simpson and Syme led to such successful results that their methods are
followed by the Edinburgh School to this day practically unaltered. So
satisfactory an agent is chloroform in Edinburgh hands, that other
anaesthetics are in that city but rarely called into requisition. All the
world over it is the anaesthetic in which the general practitioner places
his trust.

Having seen what Simpson did for anaesthesia, we
may briefly review what anaesthesia has done for humanity. That it has
entirely abolished the pain attendant upon surgery is easily recognised by
the profession and patients alike. The patient never begs for mercy
nowadays; he dreads the anaesthetic more than the knife; he has no anxiety
as to whether he 130 will feel pain or not, but rather as to whether he will
come round when the operation is over; happily after one experience he
realises that his fears were unfounded, and, if need be, will submit
cheerfully to a second administration.

The horrors of the operating-room referred to in
the preceding chapter were vanquished with the pain ; the surgeon has no
longer to steel himself for the task as formerly, to wear a stern aspect and
adopt a harsh manner. The patient has no longer to be held down by
assistants ; instead of having to be dragged unwillingly to the
operating-table—a daily occurrence sickening to the hearts of
fellow-patients and students, while it served only to harden the surgeon and
the experienced old nurse of those days—he will walk quietly to the room, or
submit patiently to be carried there, and at a word from the surgeon prepare

".... to storm The thick, sweet mystery of
chloroform, The drunken dark, the little death-in-life."

The operation is no longer a race against time;
order, method, cleanliness, and silence prevail, where there was formerly
disorder, bustle, confusion, dirt, and long-drawn shrieks. Nothing
illustrates better the progress of surgery than a picture of the operating '
room in the first decade placed beside that of an operating theatre in one
of our leading hospitals in this the last decade of the nineteenth century.
In the quiet of the patient, in the painlessness of the operation, in the
calm deliberation of the operator, and the methodical order of all around
him, in the respectful silence that prevails in the room so soon as the
patient is laid on the table, we see the direct results of the introduction
of anaesthetics. But there are other great, if less direct, results, each
making its presence known to the professional spectator. By anaesthesia
successful operations previously unheard of and unthought of were made
possible after the principle of antiseptic surgery had been established ; by
anaesthesia experimental research, which has led to numerous beneficent
results in practical surgery and medicine, was made possible. Its
introduction is an achievement of which the Anglo-Saxon race may well be
proud. Wells, Morton, and Simpson are its heroes. The United States has by
far the greater share of the honour of its discovery; but to Scotland is due
the glory which comes from the victorious fight. No event in surgery up to
1847 had had such far-reaching effects. Simpson himself looked forward to
the discovery of some agent, better than both chloroform and ether ; and it
is still possible that there may be an even greater future in store for
anaesthesia than was ever dreamt of in his philosophy.

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